# TED M. NICKLAUS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699964098
- **Authorized official:** MS. CONSTANCE SUE KLAGGE (MEDICAL RECORDS ADMIN)
- **Authorized official phone:** (806) 463-5111

## Contact information

- **Practice address:** 101 WALLACE BLVD, AMARILLO, TX 79106
- **Practice address phone:** (806) 355-7453
- **Mailing address:** PO BOX 7066, AMARILLO, TX 79114-7066
- **Mailing address phone:** (806) 463-5111
- **Mailing address fax:** (806) 463-5223

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | D2283 | TX | Yes |

## Other

- **Enumeration date:** 10/22/2007
- **Last updated:** 11/03/2007